Which costs are yours to pay?
With a basisverzekering (basic health insurance), you normally pay yourself for routine dental care as an adult, standard glasses, and adult physiotherapy for everyday complaints. Even care that is covered may still leave you with a deductible, a statutory contribution, or a bill from a provider that is not contracted. Before planned treatment, ask your insurer to put your costs in writing. If care is urgent, get urgent care first.
This guide is for adults and families who have Dutch basic health insurance. The basic package is set by Rijksoverheid (Dutch government).
Why might you receive a healthcare bill?
A healthcare bill can have four causes: care that is not covered, eigen risico (compulsory deductible), an eigen bijdrage (statutory personal contribution), or a rule in your policy. The table separates these causes, so you can ask your insurer which cost applies to you. The amounts below are for 2026.
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| Question | Cost type | What you may pay in 2026 |
|---|---|---|
| Is the care outside the statutory basic package? | Uncovered care | The full bill, unless supplementary insurance applies |
| Is it covered care subject to eigen risico? | Compulsory deductible | Up to the unused part of €385, plus any voluntary deductible; none under age 18 |
| Does covered care have an eigen bijdrage? | Statutory contribution | The set amount or percentage first. The remaining covered cost may then count toward the deductible. |
| Did you miss a referral, authorisation or provider rule? | Policy-related shortfall | Part or all of the bill, depending on your policy and the care |
Example for 2026: full removable dentures that are covered cost €1,200. You still have the entire €385 compulsory deductible, you have no voluntary deductible, and there is no other shortfall. You pay €300 as the 25% contribution, and then €385 from the remaining €900. Your insurer pays €515, while you pay €685 altogether.
Give your insurer these six details
Provide all six details: the diagnosis or medical reason for the care, the treatment or billing code, the provider you plan to use, any referral, the planned date, and the name of the device or medicine if that applies. Request a written reply covering coverage, provider contracts, prior permission, the deductible and statutory contribution, and the maximum reimbursement. Keep both the reply and the relevant policy page.
What conditions come with covered care?
The table lists covered care and the conditions that may still leave you with a bill. Age, medical reason, and policy rules remain important.
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| Care | Basic-package rule | Your costs or limits |
|---|---|---|
| Huisarts (GP, family doctor) and huisartsenpost (out-of-hours GP service) | The consultation is covered without a referral | No compulsory deductible for the consultation. Ordered blood tests, medicines and care from other providers can count toward it. |
| Hospital and medisch specialist (medical specialist) | Qualifying treatment is covered. A referral is normally required, except for urgent specialist care. | Deductible applies. Provider contracts and prior-permission rules can affect reimbursement. |
| Prescription medicines | Pharmacy medicines usually need a GVS (medicine reimbursement system) listing. Medical conditions and preferred-brand rules can apply. | Deductible applies. Some medicines also have a statutory contribution, capped at €250 per calendar year in 2026. |
| Geneeskundige ggz (medical mental healthcare) | GP care includes support from a POH-ggz (GP practice mental-health worker). Medical ggz normally needs a referral and a qualifying disorder. | No deductible for GP or POH-ggz support. Medical ggz treatment is subject to the deductible. A GP-referred verkennend gesprek (exploratory mental-health discussion) is exempt. Policy rules can limit reimbursement. |
| Pregnancy and birth care | Verloskundige (midwife) care and medically indicated birth care are covered. | No deductible for this care or kraamzorg (maternity care). Separate blood tests, medicines and transport can use the deductible. Some birth choices have a contribution. |
| Medical devices | Coverage depends on the device category, medical reason and policy conditions. | Usually deductible from age 18. A contribution, contracted supplier, prescription, use period or prior permission may apply. |
A visit to a GP does not count toward the deductible. If a laboratory, pharmacy, or hospital is used after that visit, it submits a separate claim.
For specialist care that is not urgent, check which professionals your policy accepts as referrers and whether the provider has a contract. A referral is not required for urgent specialist care.
What dental care and physiotherapy are covered?
The basic package covers dental care or physiotherapy according to your age and diagnosis. The table gives the rules for 2026.
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| Care | What the basic package covers | What it usually leaves out |
|---|---|---|
| Dental care under 18 | Most preventive care and treatment, without deductible or statutory contribution | Braces, crowns, bridges and implants usually need supplementary cover. Narrow basic-package exceptions apply; see below. |
| Dental care from 18 | Certain special dental care, full removable dentures and limited oral-surgery care | Routine check-ups, cleaning, fillings, crowns, root-canal care and routine tandarts (dentist) X-rays |
| Physiotherapy from 18 | Specific medical conditions; chronic-list care generally from treatment 21 | Ordinary complaints and the first 20 sessions per chronic-list condition |
| Physiotherapy under 18 | 9 treatments within 12 months from the first treatment; up to 9 extra if results are insufficient. Chronic-list care starts at treatment 1, subject to any time limit. | Care beyond the applicable limit when no other entitlement applies |
For children, braces are covered only under special dental-care rules. Crowns, bridges, and implants may be covered for front teeth that never developed or were completely lost in an accident. Ask the insurer to check the exact treatment.
For adults, dental X-rays are covered only if a kaakchirurg (oral surgeon) takes them, or requests them, for covered surgical dental care. If a kaakchirurg performs treatment that a regular tandarts could perform, the basic package excludes it.
In 2026, full removable dentures carry a 25% contribution. For implant-retained full dentures, the contribution is 10% for the lower jaw and 8% for the upper jaw. Covered adult dental care also counts toward the deductible.
When does coverage for adult physiotherapy begin?
Certain adult physiotherapy and exercise-therapy treatments are covered starting with treatment 1. Care on the chronic list usually begins with treatment 21. See Zorginstituut Nederland (National Health Care Institute) for the 2026 rules.
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| Condition | Basic-package cover starts | Treatment limit and conditions |
|---|---|---|
| Official chronic-list condition | Treatment 21 | Adults pay the first 20 treatments per condition unless supplementary cover pays them. Some conditions have a time limit. |
| Hip or knee artrose (osteoarthritis) | Treatment 1 | Supervised exercise therapy: up to 12 treatments within 12 months from the first treatment. |
| Claudicatio intermittens (leg pain caused by narrowed arteries) | Treatment 1 | Supervised exercise therapy: up to 37 treatments within 12 months from the first treatment. |
| Urine-incontinentie (loss of bladder control) | Treatment 1 | Pelvic physiotherapy: up to 9 treatments within 12 months from the first treatment. |
| COPD (chronic obstructive pulmonary disease), phase 2 or higher | Treatment 1 | Supervised exercise therapy: no statutory session maximum. Only medically needed care qualifies. |
| Severe limits on daily activities from reumatoïde artritis (rheumatoid arthritis) or axiale spondyloartritis (axial spondyloarthritis) | Treatment 1 | Personalised supervised exercise therapy: no statutory session maximum when the strict medical criteria are met. |
For that condition, the diagnosis, severity, provider, and any referral must satisfy the rule. Supplementary insurance may pay for ordinary sessions or for the first 20 chronic-list treatments. Check its annual limit and its provider conditions.
What medicines and mental healthcare are covered?
Whether a medicine is covered depends on the product and the medical reason you use it. Mental-health coverage depends on the care route. Before planned treatment, check these coverage rules.
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| Area | Coverage test | Action before care |
|---|---|---|
| Medicine | Check the GVS listing, medical conditions and preferred brand. Pharmacy service costs form part of the claim. | Ask your arts (doctor), apotheker (pharmacist) or insurer for a covered equivalent. A statement from your arts about medical necessity can allow a different brand. |
| Mental healthcare | GP and POH-ggz support differs from medical ggz treatment. Adult medical ggz needs the right referral, a qualifying disorder and an effective treatment. | Check the referral, diagnosis, provider contract and any prior permission before treatment starts at a private or independent clinic. |
Narrow exceptions for certain unregistered medicines and pharmacy preparations are also allowed by official medicine coverage rules. Medicines given during hospital treatment can follow the hospital-care route.
A verkennend gesprek referred by a GP has no deductible. Under basic insurance, medical ggz treatment is for adults from age 18. Mental-health treatment for children normally follows the Jeugdwet (Youth Act). Municipal social support follows a separate system.
What costs do you pay for birth care, devices, and birth control?
Look up the care or product you plan to use in the table, then check the costs you pay yourself. Birth care appears first, followed by glasses, lenses, and other devices. The amounts below are for 2026.
Wide tables can be scrolled sideways.
| Care or product | 2026 basic-package position | Own cost |
|---|---|---|
| Verloskundige care, home birth or medically indicated hospital birth | Covered | No deductible or statutory contribution for the birth care itself |
| Hospital or birth-centre birth without medical indication | Covered up to the statutory reimbursement limit | At least €22.50 per day for the mother and €22.50 per baby in 2026. Charges above the reimbursement limit can add more. |
| Kraamzorg | Covered | In 2026, you pay €5.70 per hour at home or in a chosen maternity or birth centre without medical need. At the centre, you also pay accommodation and possibly other costs, such as supplies. Hospital kraamzorg has no contribution. |
| Ordinary glasses | Ordinary lenses and frames are outside the basic package. Some children and specialised aids have medical exceptions. | You pay the full cost of ordinary glasses. Even for children with qualifying medical conditions, frames remain self-paid. |
| Medically indicated contact lenses | Covered when the medical conditions are met | In 2026: €66 per lens lasting over a year. For shorter-use lenses: €66 per lens per calendar year, up to €132. The deductible can apply afterwards. |
| Other medical devices | Only covered categories and medical conditions. Simple walking aids such as rollators are excluded. | The deductible and contribution depend on the device. In 2026, adults pay a 25% contribution for hearing aids. |
For a birth in a hospital or birth centre, the contribution stops if a medical indication arises during labour or if laughing gas is used for pain relief. Birth assistance from a maternity-care worker also has no contribution. Ask the provider to separate the costs of the birth from care after the birth.
Anticonceptiemiddelen (birth-control products) are covered before age 21, depending on product rules. From age 18, a covered product counts toward the deductible. Hormonal products may also have a contribution. Insertion or removal of a coil or implant by a GP has no deductible.
From age 21, you usually pay for birth control yourself. There are narrow medical exceptions, including endometriose (endometriosis) and bloedarmoede (anaemia) caused by heavy menstrual bleeding. Ask your insurer about the exact product and medical reason.
What does your insurance cover abroad?
On a temporary trip, Dutch basic insurance may cover care that is suddenly needed, up to the Dutch reimbursement rate. The deductible may still apply. Call the assistance number on your health or travel policy as soon as possible. Higher charges abroad and repatriëring (transport home) may require travel or supplementary insurance.
An EHIC (European Health Insurance Card) gives access to necessary public care under local conditions during a temporary stay. It applies in the EU (European Union), Iceland, Liechtenstein, Norway, Switzerland, and the United Kingdom. It does not cover planned treatment, private clinics, cruise-ship care, or transport home.
Cover through CAK (Central Administration Office) follows different rules
If you or a family member is covered through CAK, ask about the foreign scheme before applying ordinary Dutch-policy rules. Ask the CAK or the local insurer where to claim and whether planned care requires permission.
A CAK EHIC covers basic-package care in the Netherlands and necessary care in the other covered European countries. In your country of residence, use the local insurer’s card and local rules. CAK-insured residents outside these countries do not receive an EHIC. Under this scheme, they have no entitlement to care in the Netherlands or Europe, except for Dutch basic care for residents of North Macedonia.
CAK-insured residents of North Macedonia may claim reimbursement for Dutch basic care. Pay the bill first, then send it to Zilveren Kruis, Groep Buitenlands Recht (health insurer’s Foreign Law Group).
How do provider rules and policy rules affect your bill?
A naturapolis (in-kind policy) may pay less if you use a provider without a contract. A restrictive policy may have fewer contracted providers or reimburse less. A combinatiepolis (combination policy) applies different rules depending on the type of care.
Your policy may require a named supplier, a referral, a prescription, or prior permission. For your exact treatment, check the insurer’s provider finder and the current policy terms. It is not enough for a provider to say that it works with insurers. If your policy requires permission, get it before treatment.
The NZa (Nederlandse Zorgautoriteit, Dutch Healthcare Authority) supervises the duty of insurers to help you obtain covered care in time. If you face a long wait, ask for help.
Ask for help when covered care is too slow
Ask your insurer for zorgbemiddeling (care mediation). It must help you receive covered care in time. If no contracted provider can treat you in time, ask it to arrange an alternative, including care from a non-contracted provider where needed. Confirm reimbursement before you book.
What can supplementary insurance cover?
Supplementary insurance may pay for care outside the basic package or for some costs you would otherwise pay yourself. Compare its limits with the care you expect to need.
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| Expected need | What to compare | Cost to check |
|---|---|---|
| Dental care | Annual premium, reimbursement percentage, annual maximum and excluded treatment codes | A high headline maximum can still reimburse only part of each bill |
| Physiotherapy | Number of sessions, contracted-provider rules and whether the first 20 chronic-list sessions count | Cover stops when the annual session budget is used |
| Glasses, lenses or statutory contributions | Amount, frequency, approved supplier and whether the contribution is included | An allowance every 2 or 3 years may be worth less than one year of premiums |
| Already planned treatment | Acceptance, medical questions, start date, waiting period and existing-treatment exclusion | Buying a policy does not prove that this treatment is payable |
Supplementary insurance is voluntary. Insurers may refuse applicants, though this rarely happens. They may also assess your health or set a waiting period. Get acceptance before you cancel your existing supplementary cover.
For example, in 2026 Zilveren Kruis (health insurer) may assess health when you add dental cover. Its 3-star and 4-star supplementary packages have a 1-year wait for children’s braces if you had no orthodontic cover with it throughout 2025. Costs incurred during that wait remain excluded afterwards. These are this insurer’s rules.
How can you compare supplementary insurance?
Compare the amount you can use with the yearly premium. Follow these steps in order:
- Write down the care you expect in the next calendar year, including treatment codes or the number of sessions.
- Estimate what the basic package pays after the deductible, the statutory contribution, and any shortfall for non-contracted care.
- For each supplementary package, calculate the yearly premium and the expected reimbursement, using its percentage, frequency, and annual limits.
- Before choosing a package, check acceptance, waiting periods, provider contracts, and the start date.
- Decide whether the expected reimbursement and the protection against larger bills justify the premium. If not, set money aside to pay yourself.
How can you solve coverage and care problems?
Which complaint route you use depends on whether the problem involves your insurer, your provider, or access to care. SKGZ (health-insurance complaints and disputes foundation) handles complaints about insurance. The table shows the complaint routes and time limits.
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| Problem | First route | If unresolved |
|---|---|---|
| Insurer refuses or underpays reimbursement | Ask for the decision, policy clause and reconsideration in writing. | If you disagree with the reply or receive none within 4 weeks, contact SKGZ. Mediation is free; its disputes committee charges €37 in 2026. |
| Care provider’s quality, conduct or bill | Raise the problem with the provider. Its independent complaints officer can help. | Use the provider’s recognised disputes body if unresolved. Landelijk Meldpunt Zorg (National Healthcare Reporting Centre) can advise on quality complaints. |
| Incorrect billing, misleading information or continued long waits | Contact the provider or insurer first and keep the documents. | Report the issue to the NZa. It uses reports for supervision; it does not resolve individual disputes. |
SKGZ must receive your complaint within 1 year after your insurer decides on it. If the insurer does not answer the points in your complaint, SKGZ must receive it within 1 year after you submitted it to the insurer. If the insurer did not properly tell you about SKGZ, you receive 90 extra days. SKGZ cannot handle a complaint that is already before a court.
You may bring the complaint straight to court, or go to court after mediation has failed. If you agree beforehand to a binding decision, then both you and the insurer must follow it. You cannot appeal the binding decision. If it has a serious error, you can ask a court for a limited review. You must request that the court cancel the binding decision within 1 year after SKGZ sent it. The court looks at the decision, not at your original complaint.
For a complaint about a provider, the complaints officer is independent and free. You can use this officer if speaking with the provider does not solve the problem, or if you would rather not speak directly. The provider’s recognised disputes body gives a decision that binds both parties.
Landelijk Meldpunt Zorg provides information and advice. It does not resolve the complaint for you.
Before planned care or urgent care, what should you do?
For planned care, ask for the written coverage answer before treatment starts. A referral by itself does not guarantee full reimbursement. Keep your policy open when you contact the insurer.
If a situation is life-threatening, call 112. For any urgent issue besides that, start by contacting your huisarts (GP) or huisartsenpost (out-of-hours GP service). Do not wait to check costs before seeking urgent care. To check which service to call, use emergency-care guide.
For your next decision, use these guides.
- Dutch basic health insurance: your duty and deadline
- Toeslagen (allowances): choose the right benefit
- Free and subsidised legal help
Official Sources
- Rijksoverheid: Basic package in 2026 - National entitlement, 2026 deductible and major conditions.
- Rijksoverheid: Compulsory deductible - The €385 amount and care exempt from the deductible.
- Rijksoverheid: Statutory contributions - 2026 contributions and the order before the deductible.
- Rijksoverheid: GP costs - GP exemption and separate laboratory and medicine claims.
- Zorginstituut Nederland: Medical specialist care - Referral exception for urgency, deductible and provider conditions.
- Rijksoverheid: Policy types and contracted care - Network-policy differences and lower non-contracted reimbursement.
- Zorginstituut Nederland: Dental and oral care - Age limits, adult exceptions, dentures and oral surgery.
- Zorginstituut Nederland: Physiotherapy and exercise therapy - Diagnosis-specific entitlements and first-treatment exceptions.
- Zorginstituut Nederland: Chronic-condition list - First 20 adult treatments and condition-specific time limits.
- Zorginstituut Nederland: Prescription medicines - GVS, indication limits, preferred medicines and €250 cap.
- Zorginstituut Nederland: Medical mental healthcare - GP/POH-GGZ distinction, referral and deductible.
- Zorginstituut Nederland: Maternity and birth care - Medical indication, non-medical birth contribution and deductible exceptions.
- Zorginstituut Nederland: Visual aids - Glasses exclusions, medical lenses and 2026 contributions.
- Zorginstituut Nederland: Medical devices - Indications, supplier rules, permission and use periods.
- Zorginstituut Nederland: Contraception - Age rule, product contributions and medical exceptions.
- Rijksoverheid: Care while abroad - Dutch-tariff limit, EHIC limits and repatriation exclusion.
- CAK: CAK EHIC reimbursement - CAK EHIC coverage, residence-country rules and North Macedonia’s Dutch-care reimbursement exception.
- Rijksoverheid: Supplementary insurance - Voluntary cover, acceptance, premium and possible waiting periods.
- Zilveren Kruis: 2026 policy conditions - 2026 dental medical assessment, orthodontic waiting conditions and chronic-list treatment counting.
- Zorginstituut Nederland: Reimbursement complaints - Insurer reconsideration, SKGZ mediation and disputes committee.
- Rijksoverheid: Provider complaints - Provider, complaints officer and recognised disputes body.
- Nederlandse Zorgautoriteit: NZa reporting point - Signals about billing, information and access after first contacting the responsible party.
- Rijksoverheid: Contribution before deductible - Payment order and the worked denture calculation.
- Zorginstituut Nederland: Kraamzorg - 2026 hourly contribution at home and chosen centres, mandatory centre accommodation costs, and hospital and birth-assistance exemptions.
- NederlandWereldwijd (Dutch government information service): EHIC coverage - Covered countries, necessary public care and exclusions including cruise ships.
- NZa: Insurers’ duty of care - Timely covered care and the regulator’s role.
- NZa: Long waits and care mediation - Care mediation and reimbursement of a non-contracted alternative.
- Rijksoverheid: Urgent medical help - 112 for life-threatening situations and GP services for other urgent problems.
- SKGZ: Complaint procedure - 4-week response period, filing deadline and exception, €37 fee and binding decisions.
- Landelijk Meldpunt Zorg: Advice about care complaints - Advice and reporting for care-quality complaints.
- Zilveren Kruis: claim care received in the Netherlands - Official destination linked by CAK for submitting Dutch-care bills, including North Macedonia’s exception.
- SKGZ: Complaint and disputes regulations - Articles 2, 15 and 17: complaint deadlines, advance consent and the court cancellation deadline.